HomeMy WebLinkAboutS2019-0064 - Permit Application5ZU i -coo c,
�F""mow WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
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SWIMMING POOL ❑ S PAX Md
Check Aooroorlate box for Annlicant
_ ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNERS NAME LAST FIRST
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AD ESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. EN EER'S NAME LAST FIRST
LICENSE NO.
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
TY STATE, ZIP
PHONE NO.
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5. TRACTO NAME
BUSINESS LICENSE
STATE LICENSE
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No.6 C-rj Class
ADDRESS
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CONTRACTOR'S E-MAIL ADDRESS
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ITY ST ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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